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Pharmacy TAR (50-1) and eTAR Submission Tips

March 7, 2008

The following tips have been provided to help make the Treatment Authorization Request (TAR) process for paper and Internet submissions more effective. By following these tips, providers can prevent TARs from being deferred or denied, thus adjudicating TARs in a more timely and efficient manner.

Note:

For quicker processing, complete an eTAR. Fax Adjudication Responses (ARs) will be returned to the provider if the provider includes a fax number.

Tips for both Paper (TAR 50-1) and eTAR (Internet) Submissions:

  • Medical Justification: Rule out contract medications.
  • SIG (Directions for Use): Include the proper SIG information. If this field is left blank, the TAR will be deferred or denied for missing information.
  • ICD-9-CM Diagnosis Code: Provide proper ICD-9-CM codes for each specific drug requested.
  • Recipient Information: Verify patient’s name, date of birth (DOB) and gender.
  • Include a valid fax number.
  • Duplicate TARs: Do not send duplicate requests. Submitting the same paper TAR (fax TAR) and eTAR creates large workloads for field offices causing adjudication delays. Check the status of previously submitted TARs instead.
  • Complete deferred TARs and eTARs: Answer deferral questions instead of resubmitting the same TAR without providing the requested information. Do no submit a new TAR. (Deferred TARs are not prescreened, which allows for faster processing.)

Tips for eTAR Only
Complete reauthorizations according to specifications. The only boxes that can be changed on a reauthorization are the “Number of Refills Authorized” field and “Request Period Date – End (Thru Date)” field. If any other information needs to be updated, a new TAR must be submitted. For more information about eTAR submissions, refer to the eTAR Pharmacy NCPDP tutorial. Within the tutorial, click the “Request a New Prior Authorization” link on the “Modules” slide and then click “Review how to submit a Pharmacy PA.”

Authorized Refills Example

Instructions for Update Deferred Service via eTAR online:

  • From the home page click the “Transactions” tab and enter your User ID and password.
  • Click the “eTAR” tab and select “Pharmacy.”
  • From the “Transaction Code” drop-down menu, select “P.A. Request Only,” and click the “Continue” button.
  • From the “Request Type” drop-down menu, select “Deferred.” You will then be required to enter the Authorization Number (TCN) and Product/Service ID (NDC) and then click “Continue.”
  • Depending on the deferral, click the appropriate button, “Edit Patient” and/or “Edit Service,” at the bottom of the page.
  • Click “Continue” after edits are completed. Attach any necessary documents and click “Submit.”
  • Verify the information on the summary screen is correct.

Appropriate Special Handling Code:

  • Plan Requirement (No Special Handling): This field is automatically populated for cases where no basis of request is necessary.
  • Increase Plan Limitation (Exceeded Medical Supply Limit/Container Count Limit) – Select when the recipient has exceeded their medical supply or container count limit.
  • Medical Exception (Exceeded Code 1 Restrictions): Select when the recipient has exceeded Code 1 limits.
  • Plan Requirement (6 Prescription Limit): Select when a prescription for the recipient has exceeded the six-prescription limit.
  • Plan Requirement (Step Therapy): Select for submitting a PA for Step Therapy drugs.

Tips for Paper Submission Only:

  • Submit a legible, signed TAR.
  • Verify the fax number, provider name and provider number.
Provider Address Information Example
  • Check for current valid TARs before submitting a new TAR via the eTAR Inquiry Screen, Provider Telecommunication Network (PTN) or by calling the Telephone Service Center (TSC) at 1-800-541-5555.
  • Clearly type the drug name, National Drug Code (NDC) and date of service (DOS).
NDC Code Entry Example


Note:

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